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Front. Pediatr. | doi: 10.3389/fped.2018.00037

A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings

 Nicole A. Shilkofski1*, Amanda Crichlow2,  Julie Rice3, Leslie Cope4, Ye Myint Kyaw5, Thazin Mon6, Sarah Kiguli7 and  Julianna Jung3
  • 1Pediatrics, School of Medicine, Johns Hopkins University, United States
  • 2Emergency Medicine, College of Medicine, University of Florida, United States
  • 3Emergency Medicine, Johns Hopkins University School of Medicine, United States
  • 4Oncology, School of Medicine, Johns Hopkins University, United States
  • 5Paediatrics, University of Medicine 1, Yangon, Myanmar
  • 6Paediatrics, Yangon Children's Hospital, Myanmar
  • 7Paediatrics, Makerere University, Uganda

Introduction:
Under five mortality rates (UFMR) remain high for children in low and middle-income countries (LMICs) in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities). In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO) has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal.

Materials and Methods:
The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation.

Results:
Infectious diseases (respiratory illnesses and diarrheal disease) were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations.

Discussion and Conclusions:
Epidemiology of disease burden reported by respondents was relatively consistent with WHO country-specific UFMR statistics in each setting. Results of the needs assessment survey were subsequently used to refine goals and objectives for the simulation curriculum, and to ensure delivery of pragmatic educational content with recommendations that were contextualized for local capacity and resource availability. Effective use of the tool in two different settings increases its potential generalizability.

Keywords: Pediatric resuscitation, Simulation based training, limited resource settings, pediatric critical care, Curriculum Design, Needs Assessment, neonatal resuscitation, Developing Countries, World Health Organization, PIPES tool, Medical Education

Received: 10 Dec 2017; Accepted: 09 Feb 2018.

Edited by:

Ndidiamaka L. Musa, University of Washington, United States

Reviewed by:

Peter A. Meaney, University of Pennsylvania, United States
Scott A. Hagen, University of Wisconsin School of Medicine and Public Health, United States  

Copyright: © 2018 Shilkofski, Crichlow, Rice, Cope, Kyaw, Mon, Kiguli and Jung. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Nicole A. Shilkofski, School of Medicine, Johns Hopkins University, Pediatrics, 1800 Orleans Street, Suite 8464, Baltimore, 212871, Maryland, United States, nshilko1@jhmi.edu